Provider First Line Business Practice Location Address:
364 S PINE ST
Provider Second Line Business Practice Location Address:
SUITE B 130
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29302-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-596-9922
Provider Business Practice Location Address Fax Number:
864-596-8823
Provider Enumeration Date:
11/19/2007